Comparative efficacy of long-term anticoagulation in patients with iliofemoral acute deep vein thrombosis treated with pharmaco-mechanical catheter-directed thrombolysis

Aim: We aimed to compare the stability of pharmacologic profile, rate of symptomatic recurrent venous thromboembolism, major bleeding and the net clinical benefit on the regimen with vitamin K antagonist (VKA), low molecular weight heparin (LMWH) and direct oral anticoagulant (DOAC) for long-term anticoagulation in patients undergoing pharmaco-mechanical catheter-directed thrombolysis (PMCDT) for the treatment of deep vein thrombosis (DVT). Material and Methods: During the period from January 2019 until June 2019, data of 112 patients who underwent PMCDT for the treatment of acute iliofemoral DVT in our institution with long-term apixaban (Pfizer, Turkey) medication were prospectively collected (Group 1-DOAC). Data of control groups within January 2017- December 2018 period were collected retrospectively. Control groups consisted of PMCDT patients with extended LMWH (Tinzaparin, Abdi Ibrahim Pharma, Turkey) treatment (Group 2-LMWH; N=119) and with VKA (Coumadin, Eczacibasi Pharma, Turkey) treatment (Group 3- Control; N=111). Results: Patients treated with VKA showed a significant incompliance starting from third month up to one year. Patency rate diminished significantly below 70%. 32% of VKA patients were out of therapeutic range even in the first month leading to 40% at the end of the year. Likert Scale, Villalta/VCCS and VEINES-QOL-Sym scores confirmed the clinical data. Conclusion: This study highlights the potential role of DOAC as a reasonable alternative to VKAs/LMWH in the long-term anticoagulation strategy for DVT. We await larger clinical trials to support these findings and establish the role of DOAC as the standard of care for patients with DVT.